Comparative Outcome of Computed Tomography-guided Percutaneous Radiofrequency Ablation, Partial Nephrectomy or Radical Nephrectomy in the Treatment of Stage T1 Renal Cell Carcinoma

Abstract

Renal cell carcinoma (RCC) accounts for 3% of all cancers in adults. The indications for Radiofrequency Ablation (RFA) for renal carcinomas include T1a (tumor 4 cm or less, limited to the kidney), elderly patients, renal impairment, comorbidities, poor surgical candidate, and multiple bilateral renal masses. We retrospectively reviewed medical records, specifically investigating the indications, complications and outcomes of RFA and nephrectomy for treatment of RCC in a tertiary medical center with a predominantly Hispanic patient population. Forty-nine patients with RCC were evaluated. Nine patients had RFA, 9 had partial nephrectomy and 31 had radical nephrectomy. All patients among the 3 groups had stage T1N0M0 RCC at diagnosis. Tumor recurrence was observed in 2 (22%) patients that had RFA, one (11%) patient that had partial nephrectomy and no patients that had radical nephrectomy. One patient had recurrence of the tumor at the opposite kidney pole from the initial RFA site 4 years later. This particular patient did not have any tumor recurrence at the site of the initial RFA. A second RFA was performed on the recurrent tumor with no recurrence upon subsequent follow up visits. The second patient had recurrence of the RCC on 1 year follow that was discovered to be sarcomatoid RCC, which is an aggressive type with a poor prognosis. Our results support the clinical utility of RFA in patients with stage T1 RCC who are poor surgical candidates or those with reduced renal function. The clinical utility of RFA as an equally effective approach when compared to partial nephrectomy in patients with stage T1 RCC that meet strict indications for the procedure. The treatment choice should be individualized and based on the characteristics of the renal tumor such as size, location and histological type of RCC. We conclude that RFA presents a safe treatment choice for patients with RCC if long term follow up is maintained.

Renal Functional Outcomes after Surgery, Ablation, and Active Surveillance of Localized Renal Tumors: A Systematic Review and Meta-Analysis

“…Continuous Outcomes. A total of seven studies assessed continuous renal functional outcomes, showing generally worse outcomes for RN compared with TA (15,(30)(31)(32)(33)(34)(35). The median decrease was 10.3 ml/min per 1.73 m 2 lower with RN than with TA, and meta-analysis showed similar difference in mean eGFR of 9.94 ml/min per 1.73 m 2 (95% CI, 7.61 to 12.26) ( Figure 2, Table 1).…”

“…Continuous Outcomes. A total of 20 studies assessed continuous renal functional outcomes, showing similar changes for PN compared with TA (15,(30)(31)(32)(33)(34)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62) (Table 1). Meta-analyses showed a larger mean increase in creatinine of 0.07 mg/dl (95% CI, 0.00 to 0.15) and a larger mean decrease in eGFR of 1.0 ml/min per 1.73 m 2 (95% CI, 20.2 to 2.1) for PN compared with TA, but neither was statistically significant (Figure 2, Supplemental Figure 1).…”

“…Meta-analyses showed no overall difference in the rate of AKI for RN versus PN with RR, 1.3 (95% CI, 0.9 to 2.0) (12,14,16,19,26,33,45,46,(64)(65)(66)(67) (Figure 4). However, a subset of four studies evaluating T1a tumors found that rates of AKI were higher for RN compared with PN (RR, 1.37; 95% CI, 1.13 to 1.66) (33,45,46,64) (Figure 4). Similarly, three studies compared RN with TA, showing that RN was generally associated with a higher rate of AKI, but results on meta-analysis were not statistically significant (RR, 1.6; 95% CI, 0.9 to 2.8) (33,45,48) (Figure 4).…”

“…However, a subset of four studies evaluating T1a tumors found that rates of AKI were higher for RN compared with PN (RR, 1.37; 95% CI, 1.13 to 1.66) (33,45,46,64) (Figure 4). Similarly, three studies compared RN with TA, showing that RN was generally associated with a higher rate of AKI, but results on meta-analysis were not statistically significant (RR, 1.6; 95% CI, 0.9 to 2.8) (33,45,48) (Figure 4). Rates of AKI for PN versus TA were comparable among six studies with RR, 1.0 (95% CI, 0.6 to 1.9) ( Figure 4) (33,45,49,50,57,58).…”

Comparison of Radical Nephrectomy and Partial Nephrectomy for T1 Renal Cell Carcinoma: A Meta-Analysis

“…Clinical guidelines were recently changed to recommend performing PN for T1 renal tumors when technically feasible based on primary renal tumor size and site [17][18][19][20]. The recommendations are in response to observational studies suggesting equivalent oncological outcomes and superior overall survival due to the lower risk of adverse renal outcomes for PN than for RN [21][22][23][24]. However, some recent RCT showed conflicting results that survival and renal function are similar for the 2 procedures.…”